Healthcare Provider Details

I. General information

NPI: 1861585283
Provider Name (Legal Business Name): WILLIAM P. COLEMAN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 CONLIN ST
METAIRIE LA
70006-2123
US

IV. Provider business mailing address

4425 CONLIN ST
METAIRIE LA
70006-2123
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-3180
  • Fax:
Mailing address:
  • Phone: 504-455-3180
  • Fax: 504-885-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number012791
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: